Encyclopedia of Pathology

Living Edition
| Editors: J.H.J.M. van Krieken

Naevus, Oral Epithelial

  • Jacqueline E. van der WalEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-28845-1_745-1



An oral epithelial nevus is a symptomless white plaque of the ventral lingual mucosa and floor of mouth, sharply defined, irregularly butterfly shaped with a wrinkled surface. It used to be regarded as a harmless developmental anomaly. As such, it has been described just a few times in the literature, especially in the early 1950s. Pindborg reported in 1972 in a study on floor of the mouth leukoplakia that a similar white lesion as an oral epithelial nevus in the floor of the mouth was not as harmless as an oral epithelial nevus should be (Cardesa and Slootweg 2006; Cooke 1956).

Kramer et al. (1978) suggested it to be a form of leukoplakia with a high risk of malignant transformation and suggested to put it in a separate category and name it sublingual keratosis. Nowadays, it seems that the lesion has returned in the category of Leukoplakia, since no further reports have been found in the literature in recent years (Pogrel 1979).

Clinical Features

  • Incidence: Oral epithelial nevi are extremely rare. Just a few cases have been described in the literature.

  • Age: Oral epithelial nevi can be found at any age.

  • Sex: There is no sex preference.

  • Site: Oral epidermal nevi are located on the ventral lingual mucosa and floor of mouth.

  • Treatment: The treatment of choice in oral epithelial nevi is surgical excision if possible. The diagnosis can then be confirmed histopathologically. Cryotherapy and CO2 laser can also be used after the diagnosis was established on a pretreatment biopsy and malignancy was ruled out (frame 1984).

  • Outcome: After excision, neither recurrences nor malignant transformation has been reported.


Histologically, oral epithelial nevi present with pronounced hyperkeratosis, hypergranulosis, and acanthosis of stratified squamous epithelium overlying normal subepithelial connective tissue. There is a well-defined demarcation between the lesion and the surrounding normal (nonkeratinized) epithelium.

Differential Diagnosis

  • Leukoplakia.

  • White sponge nevus.

  • Frictional keratosis.

  • White sponge nevus: An autosomal dominant condition due to point mutations for genes coding for keratin 4 and/or 13. It presents as an asymptomatic, bilateral and symmetric, deeply folded spongy-white lesion on the buccal mucosa. Other locations as the tongue and vestibular mucosa may also be involved. It usually appears early in life, before puberty, and increases throughout life. Microscopically, the epithelium is thickened with marked spongiosis, acanthosis, and parakeratosis. The thickening is due to marked hydropic or clear cell change within the stratum spinosum. Perinuclear eosinophilic condensation of cytoplasm is characteristic. The lesion does not need to be treated.

References and Further Reading

  1. Cardesa, A., & Slootweg, P. J. (2006). Pathology of the head and neck (p. 84). Berlin/Heidelberg: Springer-Verlag.CrossRefGoogle Scholar
  2. Cooke, B. E. D. (1956). Leukoplakia buccalis and oral epithelial naevi: A clinical and histological study. The British Journal of Dermatology, 68, 151–174.CrossRefPubMedGoogle Scholar
  3. Frame, J. W. (1984). Treatment of sublingual keratosis with the CO2 laser. British Dental Journal, 156, 243–246.CrossRefPubMedGoogle Scholar
  4. Kramer, I. R., El-Labban, N., & Lee, K. W. (1978). The clinical features and risk of malignant transformation in sublingual keratosis. British Dental Journal, 144, 171–180.CrossRefPubMedGoogle Scholar
  5. Pogrel, M. A. (1979). Sublingual keratosis and malignant transformation. Journal of Oral Pathology, 8, 281–284.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Pathology, Antoni van Leeuwenhoek HospitalThe Netherlands Cancer InstituteAmsterdamThe Netherlands